What aspects of the health technology assessment process recommended by international health technology assessment agencies received the most attention in Poland in 2008?

Kolasa, Katarzyna; Dziomdziora, Malgorzata; Fajutrao, Liberty

doi:10.1017/s0266462310001236

Cited by 9 publications

(9 citation statements)

References 13 publications

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“…Further, the availability of HTA assessment reports, albeit frequently heavily redacted, makes it possible to investigate the role of various considerations (e.g. recommendations of other HTA bodies) in the recommendation by AHTAPol (Kolasa et al ., 2011a). Similar studies would be highly welcomed in Hungary, but the lack of relevant publicly available data makes them impossible.…”

Section: Discussionmentioning

confidence: 99%

When health technology assessment is confidential and experts have no power: the case of Hungary

Csanádi

Löblová

Ozierański

et al. 2018

HEPL

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Health technology assessment (HTA) is not simply a mechanistic technical exercise as it takes place within a specific institutional context. Yet, we know little about how this context influences the operation of HTA and its ability to influence policy and practice. We seek to demonstrate the importance of considering institutional context, using a case study of Hungary, a country that has pioneered HTA in Central and Eastern Europe. We conducted 26 in-depth, semi-structured interviews with public- and private-sector stakeholders. We found that while the HTA Department, the Hungarian HTA organisation, fulfilled its formal role envisaged in the legislation, its potential for supporting evidence-based decision-making was not fully realised given the low levels of transparency and stakeholder engagement. Further, the Department's practical influence throughout the reimbursement process was perceived as being constrained by the payer and policy-makers, as well as its own limited organisational capacity. There was also scepticism as to whether the current operational form of the HTA process delivered 'good value for money'. Nevertheless, it still had a positive impact on the development of a broader institutional HTA infrastructure in Hungary. Our findings highlight the importance of considering institutional context in analysing the HTA function within health systems.

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Section: Discussionmentioning

confidence: 99%

When health technology assessment is confidential and experts have no power: the case of Hungary

Csanádi

Löblová

Ozierański

et al. 2018

HEPL

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“…Since the mid‐2000s, Poland has pioneered HTA in CEE drawing on Western institutional solutions (Niżankowski and Wilk ). However, while the evaluation of drugs has been increasingly compliant with formal HTA requirements (Kolasa, Dziomdziora and Fajutrao ), the AHTAPol, the Polish HTA agency, has experienced strong political and corporate pressures (Niżankowski and Wilk ; Ozierański, McKee, and King b).…”

Section: The Puzzle Of Poland's Drug Reimbursement Policymentioning

confidence: 99%

The persistence of cliques in the post‐communist state. The case of deniability in drug reimbursement policy in Poland

Ozierański¹,

King

2016

British Journal of Sociology

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This article explores a key question in political sociology: Can post-communist policy-making be described with classical theories of the Western state or do we need a theory of the specificity of the post-communist state? In so doing, we consider Janine Wedel's clique theory, concerned with informal social actors and processes in post-communist transition. We conducted a case study of drug reimbursement policy in Poland, using 109 stakeholder interviews, official documents and media coverage. Drawing on 'sensitizing concepts' from Wedel's theory, especially the notion of 'deniability', we developed an explanation of why Poland's reimbursement policy combined suboptimal outcomes, procedural irregularities with limited accountability of key stakeholders. We argue that deniability was created through four main mechanisms: (1) blurred boundaries between different types of state authority allowing for the dispersion of blame for controversial policy decisions; (2) bridging different sectors by 'institutional nomads', who often escaped existing conflicts of interest regulations; (3) institutional nomads' 'flexible' methods of influence premised on managing roles and representations; and (4) coordination of resources and influence by elite cliques monopolizing exclusive policy expertise. Overall, the greatest power over drug reimbursement was often associated with lowest accountability. We suggest, therefore, that the clique theory can be generalized from its home domain of explanation in foreign aid and privatizations to more technologically advanced policies in Poland and other post-communist countries. This conclusion is not identical, however, with arguing the uniqueness of the post-communist state. Rather, we show potential for using Wedel's account to analyse policy-making in Western democracies and indicate scope for its possible integration with the classical theories of the state.

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“…In the second case, transparency of HTA decisions, research has concentrated on AHTAPol's recommendations and their relatively weak relationship with the final reimbursement decisions Malinowski 2016, Kolasa, Dziomdziora, andFajutrao 2011). The AHTAPol also faced complaints that, although its recommendations were publicly available, extensive redactions often made it impossible to understand their content (Plisko n.d.).…”

Section: Introductionmentioning

confidence: 99%

“…Given the many interests this inevitably attracts, and the global trends towards evidence-based policymaking and good governance, it is unsurprising that transparency has been a long established principle of good practice in HTA (Drummond et al ., 2008). Notably, it is part of the mission and value statement of the European Union network for Health Technology Assessment (2017), and has been put forward as a solution to the less-than-perfect utilisation of HTA by decision-makers (Sorenson et al ., 2008) or the low acceptance of its outputs by the public and stakeholders (Panteli et al ., 2015). Recommendations to increase transparency of HTA are commonplace (Hailey, 2003; Franken et al ., 2012), but systematic evaluations of the levels of transparency achieved by individual HTA agencies in practice have been relatively rare thus far (Inotai et al ., 2012), with a recent comparison of availability of information in formal decision-making frameworks in 36 countries being a rare exception (Panteli et al ., 2015).…”

Section: Introductionmentioning

confidence: 99%

Transparency in practice: Evidence from ‘verification analyses’ issued by the Polish Agency for Health Technology Assessment in 2012–2015

Ozierański

Löblová

Nicholls

et al. 2018

HEPL

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Transparency is recognised to be a key underpinning of the work of health technology assessment (HTA) agencies, yet it has only recently become a subject of systematic inquiry. We contribute to this research field by considering the Polish Agency for Health Technology Assessment (AHTAPol). We situate the AHTAPol in a broader context by comparing it with the National Institute for Health and Care Excellence (NICE) in England. To this end, we analyse all 332 assessment reports, called verification analyses, that the AHTAPol issued from 2012 to 2015, and a stratified sample of 22 Evidence Review Group reports published by NICE in the same period. Overall, by increasingly presenting its key conclusions in assessment reports, the AHTAPol has reached the transparency standards set out by NICE in transparency of HTA outputs. The AHTAPol is more transparent than NICE in certain aspects of the HTA process, such as providing rationales for redacting assessment reports and providing summaries of expert opinions. Nevertheless, it is less transparent in other areas of the HTA process, such as including information on expert conflicts of interest. Our findings have important implications for understanding HTA in Poland and more broadly. We use them to formulate recommendations for policymakers.

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What aspects of the health technology assessment process recommended by international health technology assessment agencies received the most attention in Poland in 2008?

Cited by 9 publications

References 13 publications

When health technology assessment is confidential and experts have no power: the case of Hungary

When health technology assessment is confidential and experts have no power: the case of Hungary

The persistence of cliques in the post‐communist state. The case of deniability in drug reimbursement policy in Poland

Transparency in practice: Evidence from ‘verification analyses’ issued by the Polish Agency for Health Technology Assessment in 2012–2015

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